Provider Demographics
NPI:1366761371
Name:GREENE, BRENDA MARIE (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARIE
Last Name:GREENE
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4937
Mailing Address - Country:US
Mailing Address - Phone:240-517-2650
Mailing Address - Fax:844-692-9008
Practice Address - Street 1:7310 RITCHIE HWY
Practice Address - Street 2:SUITE 406
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3065
Practice Address - Country:US
Practice Address - Phone:240-517-2650
Practice Address - Fax:844-692-9008
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153685363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health